Kingdom’s disease burden shifting

A woman has her blood sugar checked at a diabetes clinic in Phnom Penh in 2013. With a rise in diabetes, cancer and cardiovascular diseases, Cambodia is facing a double burden of infectious and noncommunicable diseases, experts say. Scott Howes

Kingdom’s disease burden shifting

Cambodia is facing the double burden of infectious and noncommunicable diseases, experts say, but the country can still prevent the problem from becoming “catastrophic” by implementing adequate measures and funnelling appropriate funding to tackle chronic illnesses.

Vicky Houssiere, communications officer with WHO Cambodia, said cardiovascular diseases, cancers, chronic respiratory diseases and diabetes are a “large and growing problem in the country”.

“Due to epidemiologic transition, Cambodia is facing the double burden of communicable diseases and non-communicable diseases,” she said in a statement.

The WHO Noncommunicable Diseases Progress Monitor 2017 showed that noncommunicable diseases accounted for 61 percent of total deaths in Cambodia, she said.

Recent government statistics also appear to reflect the transition. The number of patients who received cancer treatment at public health facilities increased by 25 percent to 8,360 in 2017, up from 6,685 patients in 2016, according to the annual report from the Ministry of Health released last week.

Dr Eav Sokha, director of the recently opened National Cancer Center at Calmette Hospital, said the number of patients seeking cancer treatment goes up as the public becomes more aware of the disease, and as services expand.

However, there are still only two public health facilities offering cancer treatment, both in Phnom Penh.

The number of patients seeking treatment for hypertension and diabetes also jumped in 2017, with diabetes, in particular, disproportionally affecting women. A total of 56,152 patients used public health facilities in 2017 for services related to diabetes, up more than 33 percent from 2016, according to the report.

However, only 7,448 of those received treatment, with the rest receiving counselling.

Dr Hor Bun Leng, a public health expert, said current data is mostly from people seeking care services, and more concrete research and surveys are needed “in order to identify the real scope of the burden of chronic diseases”.

People in Cambodia still lack knowledge of chronic diseases, he added. Many don’t go to the doctor for regular check-ups, only for treatment when they are already ill.

“We miss the early stage of chronic diseases,” he said. “When they seek treatment they are in the latest stages.”

Bun Leng said he believed the figures on chronic diseases might be “underestimated”, adding that not enough funding is going toward chronic diseases. Millions of dollars have been poured into combating infectious diseases, meanwhile.

Chhun Loun, chief of the noncommunicable diseases bureau at the Ministry of Health, said noncommunicable diseases are increasing at a faster rate than infectious diseases, with the main contributing factors being lifestyle changes, an ageing population and urbanisation.

Maurits van Pelt, co-founder and director of MoPoTsyo Patient Information Centre – an NGO helping people suffering from chronic diseases – said Cambodians are beginning to adopt more Western-influenced lifestyles, with the attendant increases in risk factors such as obesity, as they become more exposed to advertising.

It’s “all part of a very effective marketing by very large international corporations that push industrialized processed foods and create a demand for their products among young people”, he said via email.

“This is a big tragedy in the making for Cambodia society,” he said of the burden of noncommunicable diseases.

Loun’s bureau has a policy to try to reduce noncommunicable diseases by strengthening health care services at the primary care level.

But “we lack resources, like financial and human resources to reduce the burden of the diseases”, she said. “It’s very difficult for specialised services. The government doesn’t support specialists to train outside [the country]. That depends on donors.”

Loun wasn’t able to provide the overall budget for noncommunicable diseases as it involves several departments, but said the budget allocation for her department in 2017 was only $70,000, and that came from NGOs. The government’s contribution was “very small”, she added.

Screening for diabetes and high-blood pressure for people aged 40 and up, and for cervical cancer among women aged 30 to 49, is only being carried out at 16 health centres out of more than 1,000 throughout the country.
“We need . . . more money to scale up our programs,” she said.

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